Bulimia Nervosa: Benefits of Therapy

Bulimia Nervosa: Benefits of Therapy

By: Julissa Acebo

Bulimia Nervosa is an eating disorder marked by binging (consuming large amounts of food in a short period of time), followed by methods to avoid weight gain (i.e. self-induced vomiting). Primary treatments for bulimia nervosa include psychotherapy (i.e. cognitive behavior therapy), antidepressants, and nutritional counseling.

The major benefits of therapy for bulimia nervosa include, but are not limited to:

  1. A chance for clients to express themselves in a safe environment
    • An individual may have several questions or concerns about their disorder and their ability to overcome it which can be addressed in therapy
    • Provides clients with an opportunity to speak freely about their feelings and concerns
    • Judgement free zone
  2. Enhancement of the client’s understanding of their condition
    • A therapist can help you understand the unique factors that led to the development of your eating disorder
    • You will gain insight into the risks and effects of the disorder on your life
    • Your therapist will discuss steps needed to be taken to overcome bulimia nervosa
  3. Identification and treatment of co-occurring disorders
    • Patients with eating disorders often have co-occurring mental health problems (i.e. bipolar disorder, depression, anxiety, etc.)
    • Your therapist will look for and will identify any co-existing disorders and proper treatment will be recommended, this will improve patient outcomes overall
  4. Development of better body image and self-esteem
    • One of the goals in therapy will be to evaluate the client’s self-esteem and body image
    • If your therapist finds that you have low self-esteem and/or a negative body image, they will work with you to correct these issues through therapy
    • In turn will reduce the chances of relapse after treatment is complete

If you or someone you know is experiencing Bulimia Nervosa please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Source:

Grief: Losing a Parent to Suicide

Grief: Losing a Parent to Suicide

By Emily Ferrer

Suicidal thoughts are one of the most dreadful experiences one can go through and it is even more dreadful when the act of suicide is carried out by someone you love. The impact of suicidal thoughts on an individual is grueling, painful, and terrifying. However, many people tend to forget about the terrifying and painful part that the individual’s family and friends go through as well. The attention around suicide is always so focused on the suicidal individual that many people forget about the impact it can have on their loved ones. In fact, have you ever thought about losing a parent to suicide? It may seem horrifying and extraordinary; but it is more common than you think. Individuals who are at most risk to die by suicide are adults over the age of 45. More specifically, women are most at risk between the ages of 45-54 and men are most at risk ages 85 and older[1]. Many people may find this shocking, as the media portrays suicide rates to be the most high in adolescents and teens, but this is just not the case. Older individuals usually have undiagnosed or untreated depression and anxiety, a lack of frequent social interactions, suffer from underlying illnesses that may increase their attempt to be more successful, and/or suffer from chronic illnesses that may increase their depression and anxiety[2].

As saddening as these statistics are, it is even worse to see that between 7,000 and 12,000 children lose a parent to suicide every year[3]. It is devastating for children to experience such a traumatic event in their lives, especially someone they loved, admired, and relied on unconditionally. Losing a parent to suicide is not like normal grief that you experience after losing someone to a physical illness or accident. Losing a parent to suicide is grieving on steroids. “Grief comes in waves and grief from suicide comes in tsunami waves”, is great quote that explains how dreadful suicide grief can feel. Children of parents who died by suicide can experience an enormous range of emotions that can cause them to feel very confused. These emotions include[4]:

  • Shock                              – Panic                                       – Despair
  • Confusion                       – Intense anger                          – Disgust
  • Denial                             – Intense sadness                      – Feelings of abandonment or rejection

It is important to know that losing a parent to suicide is extremely unfortunate and traumatic. The emotions tied to suicide grief are understandable and completely normal. Staying close to family and friends during such a difficult time is crucial and can enormously help with healing. It is also critical to feel the emotions you experience and to not turn them away as it is a part of the healing process. Seeking professional help if you are feeling overwhelmed with these emotions or experiencing them for a long time is also is a good way to heal in the healthiest way possible.

If you or someone you know is grieving a lost one due to suicide, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com


Sources:

[1] https://www.samhsa.gov/suicide/at-risk#:~:text=Adults%20Over%20the%20Age%20of%2045&text=Eighty%20percent%20of%20all%20deaths,and%20access%20to%20lethal%20means.

[2] https://www.prb.org/resources/in-u-s-who-is-at-greatest-risk-for-suicides/

[3] https://www.hopkinsmedicine.org/news/media/releases/children_who_lose_a_parent_to_suicide_more_likely_to_die_the_same_way#:~:text=In%20the%20United%20States%2C%20each,to%20suicide%2C%20the%20researchers%20estimate.

[4] https://psychcentral.com/lib/an-open-letter-to-children-who-lose-a-parent-to-suicide#mental-health-effects

Deep Brain Stimulation and Electroconvulsive Therapy: What are they?

Deep Brain Stimulation and Electroconvulsive Therapy: What are they?

By Emily Ferrer

Deep Brain Stimulation (DBS) is a brain surgery involving the implantation of electrodes in certain areas of the brain to treat different movement disorders such as OCD, dystonia, Parkinson’s disease, and epilepsy as well as other disorders such as depression and drug addiction[1]. These electrodes produce electrical impulses to regulate certain brain functions[2] and are controlled by a pacemaker-like device. This pacemaker is placed in your chest with a wire that runs from the pacemaker to the electrodes that were inserted into your brain[3]. The parts of the brain that the electrodes are inserted into are specific to the patient and their specific symptoms. For example, for a patient who suffers from severe OCD the electrodes would be placed in an area of the brain called the ventral capsule/ventral striatum, which has been found to be very effective for patients suffering from treatment resistant OCD at about a 61.5% positive response rate[4].

Electroconvulsive Therapy (ECT) is a medical treatment usually preformed on patients who suffer from severe clinical depression and are treatment resistant to other options to help their condition[5]. The treatment involves small electric currents being passed externally through the patient’s skull between the voltage ranges of 180 to 460 volts. While there is still much controversy and incorrectly portrayed media about this procedure, it is significantly safer today than it was almost 100 years ago. The patient is put under general anesthesia at a hospital during the entire treatment and wakes up after not feeling anything from the procedure. The only thing patients feel after the completion of the treatment is an increase in positive mood. A study done in 2007 revealed that out of the patients who did and did not receive ECT for their treatment resistant depression, 71% of the participants in the experimental group, that received ECT,  found they had a positive response. This is significant when compared to the control group, who did not receive ECT, where only 28% of the participants found they had a positive response to just antidepressant medication[6].  ECT has gained a lot of popularity recently because of how quickly and effectively you feel the effects after a few treatments. The positive effects increase even more quickly when combined with psychotherapy in between the ECT treatments.

If you or someone you know is experiencing OCD or major depressive disorder and are interesting in pursuing these treatments, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com


Sources:

[1] https://atm.amegroups.com/article/view/16268/html

[2] https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562

[3] https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562

[4] https://iocdf.org/expert-opinions/expert-opinion-dbs/#:~:text=Another%20important%20development%20for%20treatment,targeted%20areas%20of%20the%20brain.

[5] https://www.webmd.com/depression/electroconvulsive-therapy

[6] https://doi.org/10.1111/j.1600-0447.1997.tb09926.x

Seasonal Affective Disorder (SAD): What is SAD?

            Seasonal Affective Disorder (SAD): What is SAD?

By: Julissa Acebo

Do you ever feel down, or not like your usual self during the shorter days in the fall and winter, and then begin to feel better in the spring and summer with longer daylight hours? This can be a sign of seasonal affective disorder (SAD), also known as seasonal depression. So what exactly is SAD? According to Mayo Clinic, it is a mood disorder characterized by depression that occurs in climates where there is less sunlight at certain times of the year. These mood changes begin and end when the seasons change. This can affect the way you think, feel, and handle daily activities.

Winter-Pattern SAD or Winter Depression

  • More common
  • Symptoms start in the late fall or early winter and go away during the spring and summer
  • Symptoms include oversleeping, overeating, weight gain, and social withdrawal

Summer-Pattern SAD or Summer Depression

  • Less common
  • Depressive episodes during the spring and summer months
  • Symptoms include trouble sleeping, poor appetite, anxiety, and episodes of violent behavior

If you or someone you know is experiencing Seasonal Affective Disorder (SAD), please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Sources:

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

Retirement: The Pros and Cons of Early Retirement

Retirement: The Pros and Cons of Early Retirement

By Emily Ferrer

Retirement is thought to be one of the most admirable events that happen in one’s life. However, there is also a darker side to retirement that many people do not know about when making the big decision to take their 401K savings investment and leave their jobs. Retirement, although seemingly glamorous and freeing, can also be extremely lonely, unfulfilling, and cause major financial issues. The average age of retirement in the U.S. is 63 years[1] and the average lifespan of a person in the U.S. is 79.1 years[2].  This means that many people, on average, have 16 more years after retirement to accomplish everything they have always wanted to do. While 16 years may not seem like a very long time to some people, it can feel extremely long to many retired individuals who only make $1,620 a month through social security, become empty nesters in their homes, or have lost their spouse or friends to old age and illness. Therefore, it is important to be aware of the pros and cons before retiring from your job.

Pros:

  • May improve physical health by having more time to exercise, get outside, and eat healthier[3]
  • More time to travel
  • More time to pursue passions
  • More time for friend and family relationships

Cons:

  • May lead to decline in mental health (e.g. depression, suicidal ideation, anxiety, panic)
  • May lead to feelings of loneliness and boredom
  • Feelings of loss of purpose in life
  • Lack of daily structure
  • Social Security benefits will be smaller if retiring earlier than your “full retirement age”[4]
  • Losing employer-sponsored health benefits
  • Outliving your savings

It is important to be aware of the issues that retiring early may cause. After retirement, it is vital to keep an active life style, both mentally and physically. This includes keeping up with preventive care, exercising regularly, eating and drinking healthily, staying social with friends and family, and finding a new purpose in life[5]. However, if you are struggling mentally due to early retirement, it is vital to seek professional treatment to avoid any more serious symptoms.

If you or someone you know is struggling with retirement and/or depression, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com


[1] https://www.forbes.com/advisor/retirement/average-retirement-age/#:~:text=While%20the%20average%20U.S.%20retirement,retirement%20benefit%20is%20roughly%20%241%2C620.

[2] https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf

[3] https://www.investopedia.com/articles/personal-finance/073114/pros-and-mostly-cons-early-retirement.asp#:~:text=Pros%20of%20retiring%20early%20include,depressing%20effect%20on%20mental%20health.

[4] https://www.investopedia.com/articles/personal-finance/073114/pros-and-mostly-cons-early-retirement.asp#:~:text=Pros%20of%20retiring%20early%20include,depressing%20effect%20on%20mental%20health.

[5] https://www.bankerslife.com/insights/healthy-aging/9-healthy-habits-for-healthy-retirement/

Self-Diagnosing: Why it’s bad to do it

Self-Diagnosing: Why it’s bad to do it

By Erika Ortiz

You feel an itchy throat, sneezing, coughing here and there, body feels a bit sore. You wonder what it can be so you look it up. Dr. Google says you’re dying and Dr. TikTok says you’re terminal! Now you’re stressing out thinking your cold turned out to be something fatal. We are all guilty of self-diagnosing. However, as innocent as it may seem, it can lead to a lot of serious issues down the road. Essentially, self-diagnosing is the process of giving yourself a medical condition based on what you know or searched, without any real credentials.

               Recently, on the social media app called “TikTok”, many creators post videos claiming, “Signs that you have depression”, or, “You have OCD if you do these things”. Although this is a great way to normalize mental health and eliminate the negative stigma around it, people are naturally easily influenced beings that want to relate to others whether it is negative or positive. However, self-diagnosing based on what you see on the web is usually not the best course of action to take when searching for real help. One issue with self-diagnosing is that it is over-simplified. Diagnosing someone is an extremely complicated process that needs to be met with certain criteria and even the specifics of the diagnosis varies immensely based on specific symptoms. It really isn’t “cut and dry”, it is a much layered process. In addition, this can lead to getting improper and ineffective medical attention or a treatment plan you may not need which can delay any potential, real help you  actually need. The information you may see online can be well-intentioned, however, it can still be misinformation which can be misread and misunderstood.

               Self-diagnosing creates a feeling of validation and security for people who may feel uncertain or confused as to why they are feeling a certain way. It is perfectly fine to do your own research, in fact it is encouraged. Being self-aware is important; however, it is also important to understand the differences between the traits you may exhibit and actual symptoms you read or see online that can pertain to a certain disorder. Before you self-diagnose based on information on Google, ask questions such as, “Is this person a professional?”, “Is the creator posting this to get paid or is it well-intention?”, or, “Does this actually apply to me specifically or generally?”  In conclusion, it’s better to try and avoid the self-diagnosis and to seek qualified professional help.

If you or someone you know wants diagnosis on mental health please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Sources:

https://www.everydayhealth.com/emotional-health/young-people-are-using-tiktok-to-diagnose-themselves-with-serious-mental-health-disorders/

https://news.harvard.edu/gazette/story/2015/07/self-diagnosis-on-internet-not-good-practice/

https://ct.counseling.org/2022/03/self-diagnosis-in-a-digital-world/#

Avoidant Attachment Style: In Relationships

Avoidant Attachment Style: In Relationships

By: Brianna Richardson

Avoidant Attachment Style

Bowlby conceptualized four attachment styles that result from a child’s relationship with their primary caregiver. One of these three attachment styles is known as avoidant (also known as dismissive) attachment style. A child develops avoidant (dismissive) attachment style, when their primary caregiver is emotionally unavailable, or unresponsive to their child’s emotional needs.

Avoidant attachment style develops in children when his/her primary caregiver neglects or discourages their child’s outward expression of emotions.

This can look like:                                                                           

  • Minimizing the child’s feelings.
  • Mocking the child while he or she is crying.
  • Ignoring the child’s expressions of emotion.
  • Displaying annoyance towards the child’s expressions of emotion.
  • Rarely or never displaying affection.

How Avoidant Attachment Effects Relationships

As a result of a parent’s disregard for their child’s emotions, their child may portray avoidant attachment style by…

  • Detaching from their emotions and feelings.
  • Refusing to rely on anyone for emotional or physical support.
  • Distrusting others.

This can cause difficulty in forming new or in preexisting relationships during adulthood. Here are some examples…

  • Avoiding emotional closeness within their relationships.
  • Refusing emotional or physical help from partners.
  • Withdrawing during times of distress or during difficult conversations.
  • Never opening up about personal hardships or emotions.

If you or someone you know wants couples counseling please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Sources:

https://www.webmd.com/parenting/what-is-avoidant-attachmentources

https://www.medicalnewstoday.com/articles/avoidant-attachment#what-is-it

OCD & Hoarding: How They’re Related

OCD & Hoarding: How They’re Related

By: Brianna Richardson

What is OCD?

Obsessive Compulsive Disorder is a psychological disorder in which an individual experiences obsessions and compulsions.

            Obsessions are characterized as ongoing intrusive thoughts, images, or urges that cause psychological distress.

            Compulsions are characterized by repetitive (physical or mental) behaviors that are performed in an attempt to alleviate the distress or anxiety which is associated with obsession.

How Does This Relate to Hoarding?

The link made between OCD and Hoarding is known as Compulsive Hoarding (or Hoarding Obsessive Compulsive Disorder; Hoarding OCD). People with Hoarding Obsessive Compulsive Disorder experience frequent intrusive thoughts or urges about acquiring material items and/or anxiety about discarding material items.

What Does Compulsive Hoarding Look Like?

Compulsive Hoarding can present itself in many ways. Here’s one example.

                        ‘My house is cluttered; I don’t have much room to walk. Maybe I should get rid of somethings? I’ll start with this pile of hair brushes… I can’t get rid of all these hairbrushes… What if two of them break, and then I misplace another? What if someone needs to borrow one? I have to keep them. I don’t want to regret throwing them away.’

                        This person is experiencing intrusive thoughts, urges, anxiety and compulsions.

Other Signs May Include

  • Difficulty discarding items
  • Extreme clutter (at workspace, car, house, etc.)
    • Losing important items in clutter
    • Feeling overwhelmed by clutter
  • Compulsive need to take anything given for free
  • Never having guests over
  • Never having people over to work on repairs
  • A belief that items of no use are valuable

If you or someone you know is experiencing Compulsive Hoarding or OCD please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Sources:

https://www.treatmyocd.com/blog/what-is-hoarding-ocd

https://www.pchtreatment.com/hoarding-and-obsessive-compulsive-disorder-ocd/

Bipolar Disorder: What is Bipolar Disorder?

Bipolar Disorder: What is Bipolar Disorder?

By Lynette Rivas

Bipolar disorder is a psychiatric health disorder that causes changes to an individual’s mood, energy, and their ability to function. Bipolar disorder is accompanied by mood episodes that can last distinct periods of times, such as days or weeks. This disorder is common among families where 80% to 90% of individuals with bipolar disorder have a relative with the same diagnosis.

Mood episodes are categorized as manic, hypomanic, or depressive. A manic or hypomanic episode is when the individual is abnormally happy or in an irritable mood for an extended period of time, that is at least one week. These episodes can also include a decreased need for sleep, faster speech, uncontrollable racing thoughts, distractibility, and/or increased risky behavior. To be considered an episode, these behaviors must represent a change from the individual’s usual behavior and the symptoms must be severe enough to cause dysfunction at work or in social activities.

A hypomanic episode is less severe than a manic episode. The symptoms need to only last for at least four days and they do not cause dysfunction in daily life. A depressive episode must be at least two weeks long and include an intense feeling of sadness, loss of interest in activities, feelings of worthlessness, increased or decreased sleep, restlessness, and/or difficulty concentrating. These symptoms must also be a change from the individual’s usual behavior.

There are three types of bipolar disorders which include: bipolar I, bipolar II, and cyclothymic disorder. 

Bipolar I

Bipolar I disorder is when the individual has had at least one manic episode that may be followed by a hypomanic or a major depressive episode.

Bipolar II

Bipolar II disorder is when the individual has had at least one major depressive episode and one hypomanic episode, but has never experienced a manic episode.

Cyclothymic Disorder

Cyclothymic disorder is when the individual has had at least two years, in adolescence, where there have been many periods of hypomania and depressive symptoms.

Bipolar disorder is a serious mental health condition that is treatable with medications and psychotherapy, so it is important to seek treatment from a mental health professional if you experience any of these symptoms.

If you or someone you know is experiencing manic, hypomanic, and/or depressive episodes please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com

Sources:

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

https://psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

https://www.istockphoto.com/illustrations/bipolar-disorder

ADHD: Gender Disparities in ADHD Diagnoses

ADHD: Gender Disparities in ADHD Diagnoses

By Jackie Molan

Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, impulsive behaviors, difficulty paying attention, and high distractibility. ADHD is one of the most common disorders of childhood, but boys are much more readily diagnosed than girls. It is believed that the prevalence of ADHD across genders is approximately equal, even though formal diagnoses strongly favor boys. Females are often underdiagnosed with ADHD and misdiagnosed with other disorders, such as bipolar, depression, and anxiety. The symptom profile for ADHD is the same across genders, but the behavioral presentation of symptoms tends to differ greatly.

Females are more likely to exhibit more internalized behavioral symptoms, such as:

  • Daydreaming
  • Losing focus
  • Forgetfulness
  • Anxiety
  • Insomnia
  • Impatience
  • Low self-esteem
  • People-pleasing
  • Deep emotional reactions/overwhelm

Males, on the other hand, often display more external behaviors, such as:

  • Hyperactivity
  • Disruptive behavior
  • Interrupting people during conversations
  • Losing items often
  • Anger outbursts

The external manifestation of ADHD symptoms makes the disorder more likely to be noticed in young boys by parents, teachers, and peers. Since young girls usually do not show such external symptoms, they tend to not receive a formal ADHD diagnosis until much later in life (if at all).

Regardless of gender, if you think you are experiencing any combination of ADHD symptoms, it is important to seek help from a mental health provider. A formal diagnosis from a professional can allow you to effectively manage your symptoms and improve daily functioning.

If you or someone you know is struggling with ADHD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.psychologytoday.com/us/basics/adhd

https://www.psychologytoday.com/us/blog/rethinking-adult-adhd/202203/why-adhd-in-women-is-so-often-overlooked

https://psychcentral.com/adhd/adhd-and-gender#recap

https://www.verywellhealth.com/add-vs-adhd-5193759